why was atropine removed from acls?

[Lurker011]

i believe that atropine should be used for asystole and PEA. these patients have a very low survival chance as is,so,why not use more drugs to try to help. do you guys still use atropine in the field even though the american heart association does not recommend it?

[chbare]

Why use something that doesn't work? Take the following scenario for example: The medicineman voodoo dance of healing doesn't appear to effect PEA/Asystole outcomes. However, PEA/Asystole survival is so low why not do the dance during a code? We don't do it because it's not effective and it adds additional cost and resource utilisation when there is no clear benefit or rational for using it.

Same concept applies with atropine in most cases. We don't perform interventions because we "think" we should. We perform interventions (usually) because there exists some sort of evidence supporting the use of said interventions.

[Kiwiology]

It was removed because there is no evidence it does anything beneficial

[systemet]

i believe that atropine should be used for asystole and PEA. these patients have a very low survival chance as is,so,why not use more drugs to try to help. do you guys still use atropine in the field even though the american heart association does not recommend it?

Bear in mind that the argument that "asystole / PEA patient have a poor outcome so we should give drug X" could be applied to any drug on the ambulance or without. For example, "asystole / PEA patients have a poor outcome, so we should give preparation H".

It was removed because there is no evidence it does anything beneficial

This. It's possible to arrest from excessive vagal tone. But it's not a common cause.

On a logical level "absence of evidence of benefit", is not the same as "evidence of absence of benefit" (I'm sure Kiwi is aware of this, I just quoted him because it seemed like a natural lead in). But ACLS is being re-evaluated in an attempt to remove therapies that are based on tradition, and focus on those that have evidence to support their use.

* Surprisingly antiarrhythmics are still included. I predict that amiodarone goes bye-bye in 2015. There's no evidence these drugs increase long-term survival.

* There's real doubt as to whether epinephrine is beneficial. This may also be removed in time. There is now some actual evidence that it has no impact on survival.

[Kiwiology]

I strongly suspect if no further evidence is found supporting adrenaline in cardiac arrest it will be removed here come September, 2013

[craig]

Atropine is stillused here, however there is talk that they will remove it, however we wont lose it as it is the only prehospital drug we carry for the dreaded funnel web spider bite.................

[Kiwiology]

sucks for you living in a land with so many dangerous creatures not like this side of the dutch

we still use it as a first-in treatment for symptomatic bradycardia

[ERDoc]

The medicineman voodoo dance of healing doesn't appear to effect PEA/Asystole outcomes. However, PEA/Asystole survival is so low why not do the dance during a code? We don't do it because it's not effective and it adds additional cost and resource utilisation when there is no clear benefit or rational for using it.

Wait. When did they take the voodoo dance out of ACLS? Is that why my nurses look at me funny when I strip off my shirt and throw on my grass skirt? I really don't have much else to add as it has all been pretty much said. Lurker, I'm not trying to attack you, but you need to need to understand that it is this sort of thing that holds EMS back. We need to move beyond "well, we've always done it this way and if it doesn't do any harm what's the big deal?" attitude and begin to incorporate EBM as much as we can.

[Quakefire]

No epi, atropine or amiodarone looks like acls is becoming less "a" and more just "cls"

Just means we need to make sure that as stuff is removed we push to get what's added in its place, or even a larger/full level of acls meds

[triemal04]

On a logical level "absence of evidence of benefit", is not the same as "evidence of absence of benefit" (I'm sure Kiwi is aware of this, I just quoted him because it seemed like a natural lead in). But ACLS is being re-evaluated in an attempt to remove therapies that are based on tradition, and focus on those that have evidence to support their use.

* Surprisingly antiarrhythmics are still included. I predict that amiodarone goes bye-bye in 2015. There's no evidence these drugs increase long-term survival.

* There's real doubt as to whether epinephrine is beneficial. This may also be removed in time. There is now some actual evidence that it has no impact on survival.

I think by 2015 amiodarone will fall into the same class that lidocaine, procainamide and magnesium now falls into; consider giving it but there is no evidence that it will decrease overall mortality. (except in certain cardiac arrests that happened for specific reasons)

The ROC trials that are underway/starting soon will be interesting to follow. The amiodarone mixture that is being used is NOT the one that is in the field currently, and, as far as I know, even used in-hospital; there is no polysorbate in it. Given that that is a large part of why amio' causes hypotension when given rapidly, can't help but wonder if that won't cause some slight changes in the results.

Anyway, my personal guess is that within 4-5 years the standard will be early defibrillation for vfib/vtach arrests, even more focus on compressions and ensuring that they are adequate, and to only consider using antiarrhythmics for vf that is refractory to several shocks and several minutes of compressions.